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SURGERY Dr Fahim Akbar
Society                   Self          Work   Family          B a la nc              e
p ro fe s s io na l                             s kill                                                     Pe rs o na l   ...
   Theory basis   surgical skill   Sympathy and love   Scientist   Engineer   Artist   Make correct decisions
The Anatomy
The Surgical Technique
Grey’s AnatomyThe Emergency Room
The HistoryPresent illness, previous history, family historyThe physical examinationInspection, palpation, percussion, aus...
Medical Record Chief complains Present illness Past history Review of systems Personal history Bearing history Fami...
The history——how to begin   gentle                            Gain confidence   Considerate                       Give...
Building the history Detective work: respect the facts Realize the critical problem Follow some rules Patient may tell...
Building the history—          Pain   The International Association for the Pain Study    "Pain is an unpleasant sensory...
Why pay attention to         Pain       motivates the individual to withdraw from        damaging situations       prote...
Building the history—   PainHow to evaluate/rate pain           Wong—Baker face
Pain: What can we learn How the pain begin Position Characteristics :      ○ Explosive ( rupture ) or Rapid or Gradual ...
Pain: reaction Purpose : To find the cause Do not believe all patients saying Overreactor:     Mild pain: Mosquito Bit...
Vomiting What How much How often                       Pathogeny Smell                            diagnosis Color Pr...
Bowel Habits   Habits change: common but    easy to ignore   The shape and size: maybe    changed with alter of diet or ...
Hematemesis or Hematochezia Hematemesis           Hematochezia                        From rectum From  throatmouth   ...
Trauma   Get the detals as precisely as possible, find    important clues      ○ When      ○ Where      ○ How      ○ Pati...
Trauma   Car/vehicle accident injury   Sport injury   Gun shot
Past history Never overlooked important histories Do not expend to much time Do with the physical examination Accord t...
System review   Respiratory system     no pharyngalgia; no chromic cough or hemoptysis; no dyspnea and      thoracalgia;...
System review   Hematopoietic system     pale shin, dizziness, blurred vision and tinnitus; impairment of memory; petech...
Family history   Many disease are familial hereditary     familial adenomatous polyposis FAP     Hypertension     Hear...
Patients emotional background   Patient       Depressed       Nerves       Fear and be afraid of the surgery       Do...
Examination Physical examination Laboratory examination X-ray CT scan MRI ( Magnatic Resonance Imaging) Endoscopy   ...
Remember   Necessary examination   Painful and inconvenient    examination   No excessive examination
Physical examination In a certain sequence Elective examination Complete later Be courteous and relax Suitable enviro...
Physical examination     Ordinary system       Inspection       Palpation       Percussion       Auscultation     lo...
Inspection Facial features Expression position             Observe by purpose Pupil                Compare with the ...
Palpation Gentle and skillful Careful, gentle and precise Fingertip is most sensitive   Mass (benign, malignant)     ...
Auscultation Important in both medicine and surgery Pneumothorax Great vessels disease Ileus Vascular lesions Heart ...
Movement and measurement
Emergency Alter to fit circumstances Make the changes History must be short and to the point Make certain the primary ...
Emergency   Primary consideration:     consciousness     Breathing     Airway open     Palpable pulse                ...
How to deal with Airway obstruction Massive bleeding Tension pneumothorax Cardiac tamponade Bone fracture Blunt trau...
Emergency physical exam Life sign is stable Make a rapid survey examination 2-3minuts to evaluate:    ○ Head    ○ Throa...
Laboratory exam Screening for asymptomatic disease Appraisal of disease contraindicate elective  surgery     emergency, ...
Imaging studies—X ray   Chest radiograph      ○ Pneumonia      ○ lung cancer      ○ Tuberculosis      ○ Rib fracture     ...
Imaging studies—X rayAbdominal X-Ray  Rupture  Obstruction
Imaging studies—X    ray     Bone Fracture
Imaging studies——CT      Why do a CT
Imaging studies——CTCT will show the nidus more specific than X ray
Imaging studies——MRI     Why do a MRI
Imaging studies——MRI MRI can display Softtissue
Basic exams Complete blood test Stool examination Urine examination Chest X-ray ECG: electrocardiograph Old patient ...
Medical consultation  Why
Thank You!
Surgery
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Surgery

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Surgery

  1. 1. SURGERY Dr Fahim Akbar
  2. 2. Society Self Work Family B a la nc e
  3. 3. p ro fe s s io na l s kill Pe rs o na l re la tio ns hip S c ie ntifi cre s e a rc h Te a c hing a b ility
  4. 4.  Theory basis surgical skill Sympathy and love Scientist Engineer Artist Make correct decisions
  5. 5. The Anatomy
  6. 6. The Surgical Technique
  7. 7. Grey’s AnatomyThe Emergency Room
  8. 8. The HistoryPresent illness, previous history, family historyThe physical examinationInspection, palpation, percussion, auscultation 1. Correct Diagnosis 2. Therapy scheduleThe laboratory examination 3. Good relationshipLaboratory examination, imaging examsOther examinationAll kinds of endoscopes, angiography
  9. 9. Medical Record Chief complains Present illness Past history Review of systems Personal history Bearing history Family history
  10. 10. The history——how to begin gentle  Gain confidence Considerate  Give confidence Sympathy  Establish relationship Understanding  Effective communication Personal charm The way is different Follow your rhythm , not the patient’s What the patient said maybe unreliability Avoid: Leading questions, wanted , wrong answers
  11. 11. Building the history Detective work: respect the facts Realize the critical problem Follow some rules Patient may tell a lie, Why? Believe your eye and mind but not your ear
  12. 12. Building the history— Pain The International Association for the Pain Study "Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage The progress of pain
  13. 13. Why pay attention to Pain  motivates the individual to withdraw from damaging situations  protect a damaged body part while it heals  to avoid similar experiences in the future Most pain resolves promptly once the painful stimulus is removed and the body has healed sometimes pain persists despite removal of the stimulus and apparent healing of the body sometimes pain arises in the absence of any detectable stimulus, damage or disease
  14. 14. Building the history— PainHow to evaluate/rate pain Wong—Baker face
  15. 15. Pain: What can we learn How the pain begin Position Characteristics : ○ Explosive ( rupture ) or Rapid or Gradual ○ Precise ( trunk ) or obscure ( viscera ) ○ Constant ( structural ) or intermittent ( functional ) How to relieve: naturally or medication Associations: intermittent claudication: vasculitis or Spinal Stenosis extremity deformity: bone fracture
  16. 16. Pain: reaction Purpose : To find the cause Do not believe all patients saying Overreactor:  Mild pain: Mosquito Bites  Moderate pain: gastric ulcer  Severe pain: vascular pain, renal or biliary colic Restore confidence Anagelsia
  17. 17. Vomiting What How much How often Pathogeny Smell diagnosis Color Projectile: ○ Intracranial hypertension
  18. 18. Bowel Habits Habits change: common but easy to ignore The shape and size: maybe changed with alter of diet or travel Intermittent alternations of constipation or diarrhea
  19. 19. Hematemesis or Hematochezia Hematemesis  Hematochezia  From rectum From throatmouth  Character of blood Character of blood  Clot Clot  Bright or dark red Bright or dark red  Tarry stool Coffee-ground  hemorrhoids
  20. 20. Trauma Get the detals as precisely as possible, find important clues ○ When ○ Where ○ How ○ Patients position ○ Consciousness ○ Retrograde amnesia ○ Check the wounds ○ Blood lose ○ Get what therapy
  21. 21. Trauma Car/vehicle accident injury Sport injury Gun shot
  22. 22. Past history Never overlooked important histories Do not expend to much time Do with the physical examination Accord to different systems System review
  23. 23. System review Respiratory system  no pharyngalgia; no chromic cough or hemoptysis; no dyspnea and thoracalgia;no afternoon fever or night sweats. Circulatory system  no palpitation and breathlessness on exertion: no precordial pain, dizziness and persistent headache; no syncope and hypertension. Digestive system  no sour regurgitation and dysphagia: no chronic abdominal ache, diarrhea and vomiting: no jaundice, hematemesis and melena Urinary system  no past history of edema and proteinuria; no pollakiuria; no urgency and painful micturition; no visible hematuria and hypertension.
  24. 24. System review Hematopoietic system  pale shin, dizziness, blurred vision and tinnitus; impairment of memory; petechia and jaundic; lymph node, liver and spleen enlargement; abnormal bony pain. Endocrine and metabolic system  no irritability, hidrosis or profound fatigue and headache; no impaired vision, exceeding thirsty and polyuria; no excessive hairiness or hair loss; no pigmentation and sexuality change. Muscle, bone and joint system  no unusual pain, redness and swelling of the joints; no deformity of joints; no limbs and trunk limitation on motion; no myoasthenia and myoatrophy. Nervous system  no persistent headache and syncope; no memorial impairment or speaking obstacle; no insomnia and consciousness obstacle; no paresthesia of skin; no paralysis and convulsion. Mental status: no hallucination, delirium and orientation obstacle; no abnormal emotion
  25. 25. Family history Many disease are familial hereditary  familial adenomatous polyposis FAP  Hypertension  Heart disease  diabetes mellitus  Colon cancers  Have the same genes  Have the similar enviroment
  26. 26. Patients emotional background Patient  Depressed  Nerves  Fear and be afraid of the surgery  Do not have confident Amputation , ileostomy, colostomy Psychiatric consultation is seldom need Surgeon is important:  Explain enough  Patient  Professional  Trustworthy
  27. 27. Examination Physical examination Laboratory examination X-ray CT scan MRI ( Magnatic Resonance Imaging) Endoscopy ○ Gastroscopy ○ Esophagoscopy
  28. 28. Remember Necessary examination Painful and inconvenient examination No excessive examination
  29. 29. Physical examination In a certain sequence Elective examination Complete later Be courteous and relax Suitable enviroment Let patient collaborate and at ease
  30. 30. Physical examination  Ordinary system  Inspection  Palpation  Percussion  Auscultation  locomotor system  Movement  measurement
  31. 31. Inspection Facial features Expression position  Observe by purpose Pupil  Compare with the normal side Consciousness Steps Droop eyelid Breast disease
  32. 32. Palpation Gentle and skillful Careful, gentle and precise Fingertip is most sensitive Mass (benign, malignant)  Boundary, tenderness, size, pain, movements
  33. 33. Auscultation Important in both medicine and surgery Pneumothorax Great vessels disease Ileus Vascular lesions Heart disease
  34. 34. Movement and measurement
  35. 35. Emergency Alter to fit circumstances Make the changes History must be short and to the point Make certain the primary considerations Physical exams must be specific
  36. 36. Emergency Primary consideration:  consciousness  Breathing  Airway open  Palpable pulse CPR?  Heart beating
  37. 37. How to deal with Airway obstruction Massive bleeding Tension pneumothorax Cardiac tamponade Bone fracture Blunt trauma to the brain/ head
  38. 38. Emergency physical exam Life sign is stable Make a rapid survey examination 2-3minuts to evaluate: ○ Head ○ Throat ○ Abdomen ○ Extremities ○ Genitalia ○ Cervical: turn the patient
  39. 39. Laboratory exam Screening for asymptomatic disease Appraisal of disease contraindicate elective surgery emergency, deadline , elective surgery interstinal rupture, great vessels rupture gastric cancer, liver cancer thyroid adenoma, inguinal hernia Diagnosis of disorders Evaluate the paitents condition
  40. 40. Imaging studies—X ray Chest radiograph ○ Pneumonia ○ lung cancer ○ Tuberculosis ○ Rib fracture ○ Pneumothorax - (lung marking)
  41. 41. Imaging studies—X rayAbdominal X-Ray Rupture Obstruction
  42. 42. Imaging studies—X ray Bone Fracture
  43. 43. Imaging studies——CT  Why do a CT
  44. 44. Imaging studies——CTCT will show the nidus more specific than X ray
  45. 45. Imaging studies——MRI Why do a MRI
  46. 46. Imaging studies——MRI MRI can display Softtissue
  47. 47. Basic exams Complete blood test Stool examination Urine examination Chest X-ray ECG: electrocardiograph Old patient ( >60 ): ○ Ultrasonic cardiography ○ blood gas analysis
  48. 48. Medical consultation Why
  49. 49. Thank You!

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